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Safe transfer of unstable patient from hospital NABH ppt.pptx

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anjalatchi
anjalatchi

Keep your body in a straight line, with a straight back and bent knees. Your head and chest should be up and straight. Keep your feet a little wider than your shoulder width. Keep the person's head, torso, and legs in line during the transfer.

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Safe transfer of unstable patient from hospital Dr. Anjalatchi Muthukumaran Vice Principal Era college of Nursing
Equipment for transfer the patients
Introduction • One of the critical task that hospitals have to frequently undertake is to transfer a critically ill or unstable patient from one hospital to another. • Transfer of such patient are likely to induce various physiological changes, which may adversely affect the health of patient even leading up-to death. • Hence, such transfers shall be undertaken with great care and as per evidenced-based guidelines. • Following are the key elements and guidelines for safely executing transfer for an unstable patient.
Criteria for identifying unstable patients • A patient whose physiological status is in fluctuation and for whom emergent treatment and/or surgical intervention are anticipated, is considered as an unstable patient. • Hospital should use clinical criteria to identify an unstable patient. • Following criteria can be used as reference for developing hospital’s own criteria
Patients with one or more of below condition shall be considered as unstable patient • Glasgow coma scale <= 14 • Pulse < 60 or > 120 beats per minute • Systolic blood pressure > 190 mmhg • Respiratory rate < 12 or > 24 breaths per minute • Poor gas exchange, with oxygen saturation < 90% • Temperature < 92°f (< 33°c) • Paralysis • Hoarseness or inability to talk • Laboured respirations • Severe pain • External haemorrhage • Combative • Severe deformity involving spine, neck, chest or extremities • Penetrating wound from head to popliteal fossa
Following co-morbid condition if present increases the risk of un-stability • Age > 55 years • History of coronary artery disease • History of COPD • History of liver disease • History of coagulation disorder • History of mental illness • Current insulin-dependent diabetes mellitus • Current anticoagulation therapy • Current pregnancy • Neonates
Decision to transfer: • The decision to transfer the patient shall be taken by a senior consultant level doctor after discussing with patient's relatives about the benefits and risks involved. • The decision of transfer shall only be taken if benefits of transferring the patient outweigh the risks involved in transferring. • A written informed consent shall be taken from patient/family before the transfer
Communication with receiving facility: • The facility where the patient is being transferred shall be informed prior to shifting. • It is always preferable that the consultant doctor of the transferring facility speaks to the consultant doctor of the receiving facility. • Complete information on patient's clinical condition, treatment being given, reasons for transfer, mode of transfer and timeline of transfer, shall be shared with the receiving facility in a written document.
Safe transfer of unstable patient from hospital NABH ppt.pptx
Pre-transfer stabilisation and preparation: • Patients should be properly stabilized and prepared before transferring to prevent any adverse event or deterioration in patient’s clinical condition during transfer. The patient should be adequately resuscitated and stabilised to the maximum extent possible. •
Safe transfer of unstable patient from hospital NABH ppt.pptx
Following points can be used as a checklist for pre-transfer stabilization • 1. Airway – If compromise in airway is suspected during transfer of patient, endotracheal tube intubation shall be done. • 2. Breathing – Arterial blood gas values should be optimized and breathing should be adequately controlled. In patients suspected of pneumothorax, chest drain shall be inserted. • 3. Circulation – Control for external haemorrhage. Ensure that cross matched blood is available during transport, if required. Haemorrhagic shock shall be adequately treated • 4. Neurological status – In case of patients with head injury their Glasgow coma scale should be adequately monitored and documented. • Patient shall also be protected from cold by provision of blankets during transfer.
Mode of transfer • Mode of transferring the patient shall be selected as per the clinical condition of the patient. • Following guidelines shall be taken into consideration. • 1. Patients with non-life threatening condition can be transported in a Basic Life-Support Ambulance. 2. Patients with life-threatening conditions or patients who may endotracheal intubation, cardiac monitoring, defibrillation, administration of intravenous fluids or vasopressors, during transfer, shall be transported using Advances Life-Support Ambulance
Continued • 3. Patients on life support system, i.e. ventilator can be transported in a mobile ICU ambulance, if available 4. In some extreme cases, where patients clinical condition is critical and time is a big factor, use of air ambulance shall be considered, if available. • However, feasibility of air transfer shall be ascertained with respect to environment, and patient’s condition. If the patient, due to his/her condition can undergo sudden decompensation during air transfer, the same shall be avoided
checklist of emergency department • Ambulance plays a vital role in emergency medical care. In-order to be able to provide best ambulance services to emergency cases, NABH has specified certain requirements to be met. As functionally ambulance is related to emergency care, it is suggested that this checklist be used in combination with checklist of emergency department.
Safe transfer of unstable patient from hospital NABH ppt.pptx
Continued • Ambulance should be identified as ALS equipped or BLS equipped. ALS equipped ambulance should be used for transferring critically ill or unstable patients. For other patients BLS equipped ambulance can be used. • ALS ambulance must be equipped with necessary resources such as transport ventilator, portable suction apparatus, portable oxygen equipment, ambu resuscitation kit (for adult and paediatric), multi-para monitors, intubation equipment, AED, syringe pumps, IV lines, immobilization devices, emergency medicines etc. • BLS equipment should be equipped with basic things like stretchers, emergency medicines, portable oxygen, suction devices, first aid kit and ambu bags. • The staff in ambulance (driver and technician) should be trained in BLS skills.
Bed to wheel chair
Continued • Ambulance should be identified as ALS equipped or BLS equipped. ALS equipped ambulance should be used for transferring critically ill or unstable patients. For other patients BLS equipped ambulance can be used. • ALS ambulance must be equipped with necessary resources such as transport ventilator, portable suction apparatus, portable oxygen equipment, ambu resuscitation kit (for adult and paediatric), multi-para monitors, intubation equipment, AED, syringe pumps, IV lines, immobilization devices, emergency medicines etc. • BLS equipment should be equipped with basic things like stretchers, emergency medicines, portable oxygen, suction devices, first aid kit and ambu bags. • The staff in ambulance (driver and technician) should be trained in BLS skills.
Safe transfer of unstable patient from hospital NABH ppt.pptx
Continued • Specific points that needs to be taken care of for ambulance are • The vehicle should be registered as an ambulance (for each vehicle being used as ambulance) • Necessary legal documents should be available and within validity period. This includes vehicle registration, driver’s license, PUC and Vehicle Insurance. (Check this post on 'all legal documents required by a hospital') • The vehicle should comply with ‘Minimum standards and guidelines for ambulances, National Ambulance code issued by Ministry of Road and transport and Highways’ • There should be an un-obstructed way for ambulance to reach till emergency entrance and take a U-turn • An identified parking spot near to emergency department should be used for parking ambulances
Safe transfer of unstable patient from hospital NABH ppt.pptx
• The staff in ambulance must have devices (mobile phone, wireless walkie talkie etc.) to communicate with hospital. If mobile phones are used, it must be ensured that the phones are functional all the time (i.e. battery is charged and adequate balance available) • Staff in ambulance must be aware basic emergency management skills like immobilization technique, safe transfer of patient, use of oxygen, medication administration etc. •
Accompanying the patient • It is recommended that two competent personnel accompany the unstable patient during transfer. The accompanying person shall be suitably trained in patient transfer, advanced cardiac life support, airway management and critical care. It is also recommended that a physician shall accompany the patient, however, if this is not possible then provision for contacting the concerned physician shall be there. For deciding who should accompany, the patient can be categorized into 4 levels
Level of patient condition • Level 0 – Patients who can be managed at the level of ward, usually do not require any specially trained person to accompany • Level 1 – These are patients who are at risk of deterioration during transfer, but can be managed in acute care setting. Such patient shall be accompanied by a paramedic or a nurse • Level 2 – These patients require observation or intervention for failure of single organ system and must be accompanied by trained and competent personnel • Level 3 – These are patients with advanced respiratory care requirement during transfer with support of at-least two failing organs. These patients shall be accompanied by a competent doctor along-with nurse or paramedic
Equipment and Drug • The ambulance transporting the patient shall be equipped with necessary equipment, monitoring devices, medicines and consumables. • All the monitoring needs to be established before the commencement of transfer along with the starting of infusion drugs. • There should be one person responsible for patient transfer, who shall ensure availability of all these.
Documentation and record • In all stages of transfer, documentation shall be clearly done. • Patient's condition, reason to transfer, names and designation of referring and receiving clinicians, details and status of vital signs before the transfer, clinical events during the transfer and the treatment given, shall be recorded in patients’ medical files. • Handing over shall also be documented and things handed over along with the patient, such as medical files, clinical reports, films etc. shall also be recorded.
Quality improvement • Any untoward incident happening during transfer shall be recorded and reported to appropriate authority. • Each such incident shall be investigated and proper corrective and preventive actions shall be taken. • Periodic audit of transfer process shall be done and the transfer records shall be reviewed.
Reference • Kulshrestha A, Singh J. Inter-hospital and intra- hospital patient transfer: Recent concepts. Indian journal of anaesthesia. 2016 Jul;60(7):451.

More Related Content

Safe transfer of unstable patient from hospital NABH ppt.pptx

  • 1. Safe transfer of unstable patient from hospital Dr. Anjalatchi Muthukumaran Vice Principal Era college of Nursing
  • 2. Equipment for transfer the patients
  • 3. Introduction • One of the critical task that hospitals have to frequently undertake is to transfer a critically ill or unstable patient from one hospital to another. • Transfer of such patient are likely to induce various physiological changes, which may adversely affect the health of patient even leading up-to death. • Hence, such transfers shall be undertaken with great care and as per evidenced-based guidelines. • Following are the key elements and guidelines for safely executing transfer for an unstable patient.
  • 4. Criteria for identifying unstable patients • A patient whose physiological status is in fluctuation and for whom emergent treatment and/or surgical intervention are anticipated, is considered as an unstable patient. • Hospital should use clinical criteria to identify an unstable patient. • Following criteria can be used as reference for developing hospital’s own criteria
  • 5. Patients with one or more of below condition shall be considered as unstable patient • Glasgow coma scale <= 14 • Pulse < 60 or > 120 beats per minute • Systolic blood pressure > 190 mmhg • Respiratory rate < 12 or > 24 breaths per minute • Poor gas exchange, with oxygen saturation < 90% • Temperature < 92°f (< 33°c) • Paralysis • Hoarseness or inability to talk • Laboured respirations • Severe pain • External haemorrhage • Combative • Severe deformity involving spine, neck, chest or extremities • Penetrating wound from head to popliteal fossa
  • 6. Following co-morbid condition if present increases the risk of un-stability • Age > 55 years • History of coronary artery disease • History of COPD • History of liver disease • History of coagulation disorder • History of mental illness • Current insulin-dependent diabetes mellitus • Current anticoagulation therapy • Current pregnancy • Neonates
  • 7. Decision to transfer: • The decision to transfer the patient shall be taken by a senior consultant level doctor after discussing with patient's relatives about the benefits and risks involved. • The decision of transfer shall only be taken if benefits of transferring the patient outweigh the risks involved in transferring. • A written informed consent shall be taken from patient/family before the transfer
  • 8. Communication with receiving facility: • The facility where the patient is being transferred shall be informed prior to shifting. • It is always preferable that the consultant doctor of the transferring facility speaks to the consultant doctor of the receiving facility. • Complete information on patient's clinical condition, treatment being given, reasons for transfer, mode of transfer and timeline of transfer, shall be shared with the receiving facility in a written document.
  • 10. Pre-transfer stabilisation and preparation: • Patients should be properly stabilized and prepared before transferring to prevent any adverse event or deterioration in patient’s clinical condition during transfer. The patient should be adequately resuscitated and stabilised to the maximum extent possible. •
  • 12. Following points can be used as a checklist for pre-transfer stabilization • 1. Airway – If compromise in airway is suspected during transfer of patient, endotracheal tube intubation shall be done. • 2. Breathing – Arterial blood gas values should be optimized and breathing should be adequately controlled. In patients suspected of pneumothorax, chest drain shall be inserted. • 3. Circulation – Control for external haemorrhage. Ensure that cross matched blood is available during transport, if required. Haemorrhagic shock shall be adequately treated • 4. Neurological status – In case of patients with head injury their Glasgow coma scale should be adequately monitored and documented. • Patient shall also be protected from cold by provision of blankets during transfer.
  • 13. Mode of transfer • Mode of transferring the patient shall be selected as per the clinical condition of the patient. • Following guidelines shall be taken into consideration. • 1. Patients with non-life threatening condition can be transported in a Basic Life-Support Ambulance. 2. Patients with life-threatening conditions or patients who may endotracheal intubation, cardiac monitoring, defibrillation, administration of intravenous fluids or vasopressors, during transfer, shall be transported using Advances Life-Support Ambulance
  • 14. Continued • 3. Patients on life support system, i.e. ventilator can be transported in a mobile ICU ambulance, if available 4. In some extreme cases, where patients clinical condition is critical and time is a big factor, use of air ambulance shall be considered, if available. • However, feasibility of air transfer shall be ascertained with respect to environment, and patient’s condition. If the patient, due to his/her condition can undergo sudden decompensation during air transfer, the same shall be avoided
  • 15. checklist of emergency department • Ambulance plays a vital role in emergency medical care. In-order to be able to provide best ambulance services to emergency cases, NABH has specified certain requirements to be met. As functionally ambulance is related to emergency care, it is suggested that this checklist be used in combination with checklist of emergency department.
  • 17. Continued • Ambulance should be identified as ALS equipped or BLS equipped. ALS equipped ambulance should be used for transferring critically ill or unstable patients. For other patients BLS equipped ambulance can be used. • ALS ambulance must be equipped with necessary resources such as transport ventilator, portable suction apparatus, portable oxygen equipment, ambu resuscitation kit (for adult and paediatric), multi-para monitors, intubation equipment, AED, syringe pumps, IV lines, immobilization devices, emergency medicines etc. • BLS equipment should be equipped with basic things like stretchers, emergency medicines, portable oxygen, suction devices, first aid kit and ambu bags. • The staff in ambulance (driver and technician) should be trained in BLS skills.
  • 18. Bed to wheel chair
  • 19. Continued • Ambulance should be identified as ALS equipped or BLS equipped. ALS equipped ambulance should be used for transferring critically ill or unstable patients. For other patients BLS equipped ambulance can be used. • ALS ambulance must be equipped with necessary resources such as transport ventilator, portable suction apparatus, portable oxygen equipment, ambu resuscitation kit (for adult and paediatric), multi-para monitors, intubation equipment, AED, syringe pumps, IV lines, immobilization devices, emergency medicines etc. • BLS equipment should be equipped with basic things like stretchers, emergency medicines, portable oxygen, suction devices, first aid kit and ambu bags. • The staff in ambulance (driver and technician) should be trained in BLS skills.
  • 21. Continued • Specific points that needs to be taken care of for ambulance are • The vehicle should be registered as an ambulance (for each vehicle being used as ambulance) • Necessary legal documents should be available and within validity period. This includes vehicle registration, driver’s license, PUC and Vehicle Insurance. (Check this post on 'all legal documents required by a hospital') • The vehicle should comply with ‘Minimum standards and guidelines for ambulances, National Ambulance code issued by Ministry of Road and transport and Highways’ • There should be an un-obstructed way for ambulance to reach till emergency entrance and take a U-turn • An identified parking spot near to emergency department should be used for parking ambulances
  • 23. • The staff in ambulance must have devices (mobile phone, wireless walkie talkie etc.) to communicate with hospital. If mobile phones are used, it must be ensured that the phones are functional all the time (i.e. battery is charged and adequate balance available) • Staff in ambulance must be aware basic emergency management skills like immobilization technique, safe transfer of patient, use of oxygen, medication administration etc. •
  • 24. Accompanying the patient • It is recommended that two competent personnel accompany the unstable patient during transfer. The accompanying person shall be suitably trained in patient transfer, advanced cardiac life support, airway management and critical care. It is also recommended that a physician shall accompany the patient, however, if this is not possible then provision for contacting the concerned physician shall be there. For deciding who should accompany, the patient can be categorized into 4 levels
  • 25. Level of patient condition • Level 0 – Patients who can be managed at the level of ward, usually do not require any specially trained person to accompany • Level 1 – These are patients who are at risk of deterioration during transfer, but can be managed in acute care setting. Such patient shall be accompanied by a paramedic or a nurse • Level 2 – These patients require observation or intervention for failure of single organ system and must be accompanied by trained and competent personnel • Level 3 – These are patients with advanced respiratory care requirement during transfer with support of at-least two failing organs. These patients shall be accompanied by a competent doctor along-with nurse or paramedic
  • 26. Equipment and Drug • The ambulance transporting the patient shall be equipped with necessary equipment, monitoring devices, medicines and consumables. • All the monitoring needs to be established before the commencement of transfer along with the starting of infusion drugs. • There should be one person responsible for patient transfer, who shall ensure availability of all these.
  • 27. Documentation and record • In all stages of transfer, documentation shall be clearly done. • Patient's condition, reason to transfer, names and designation of referring and receiving clinicians, details and status of vital signs before the transfer, clinical events during the transfer and the treatment given, shall be recorded in patients’ medical files. • Handing over shall also be documented and things handed over along with the patient, such as medical files, clinical reports, films etc. shall also be recorded.
  • 28. Quality improvement • Any untoward incident happening during transfer shall be recorded and reported to appropriate authority. • Each such incident shall be investigated and proper corrective and preventive actions shall be taken. • Periodic audit of transfer process shall be done and the transfer records shall be reviewed.
  • 29. Reference • Kulshrestha A, Singh J. Inter-hospital and intra- hospital patient transfer: Recent concepts. Indian journal of anaesthesia. 2016 Jul;60(7):451.